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Boehmer KR, Gallacher KI, Lippiett KA, Mair FS, May CR, Montori VM. Minimally Disruptive Medicine: Progress 10 Years Later. Mayo Clin Proc 2022; 97:210-220. [PMID: 35120690 DOI: 10.1016/j.mayocp.2021.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, USA.
| | - Katie I Gallacher
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Kate A Lippiett
- Macmillan Survivorship Research Group, University of Southampton, Southampton, UK
| | - Frances S Mair
- General Practice and Primary Care, University of Glasgow, Glasgow, UK
| | - Carl R May
- Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
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Osterman CK, Sanoff HK, Wood WA, Fasold M, Lafata JE. Predictive Modeling for Adverse Events and Risk Stratification Programs for People Receiving Cancer Treatment. JCO Oncol Pract 2022; 18:127-136. [PMID: 34469180 PMCID: PMC9213197 DOI: 10.1200/op.21.00198] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Emergency department visits and hospitalizations are common among people receiving cancer treatment, accounting for a large proportion of spending in oncology care and negatively affecting quality of life. As oncology care shifts toward value- and quality-based payment models, there is a need to develop interventions that can prevent these costly and low-value events among people receiving cancer treatment. Risk stratification programs have the potential to address this need and optimally would consist of three components: (1) a risk stratification algorithm that accurately identifies patients with modifiable risk(s), (2) intervention(s) that successfully reduce this risk, and (3) the ability to implement the risk algorithm and intervention(s) in an adaptable and sustainable way. Predictive modeling is a common method of risk stratification, and although a number of predictive models have been developed for use in oncology care, they have rarely been tested alongside corresponding interventions or developed with implementation in clinical practice as an explicit consideration. In this article, we review the available published predictive models for treatment-related toxicity or acute care events among people receiving cancer treatment and highlight challenges faced when attempting to use these models in practice. To move the field of risk-stratified oncology care forward, we argue that it is critical to evaluate predictive models alongside targeted interventions that address modifiable risks and to demonstrate that these two key components can be implemented within clinical practice to avoid unplanned acute care events among people receiving cancer treatment.
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Affiliation(s)
- Chelsea K. Osterman
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Hanna K. Sanoff
- Division of Oncology, Department of Medicine, University of North Carolina, Chapel Hill, NC,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - William A. Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC,Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC
| | - Megan Fasold
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC,Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC,Jennifer Elston Lafata, PhD, University of North Carolina, 2214 Kerr Hall, CB# 7573, Chapel Hill, NC 27599; e-mail:
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Boehmer KR, Pine KH, Whitman S, Organick P, Thota A, Espinoza Suarez NR, LaVecchia CM, Lee A, Behnken E, Thorsteinsdottir B, Pawar AS, Beck A, Lorenz EC, Albright RC. Do patients with high versus low treatment and illness burden have different needs? A mixed-methods study of patients living on dialysis. PLoS One 2021; 16:e0260914. [PMID: 34962932 PMCID: PMC8714126 DOI: 10.1371/journal.pone.0260914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/21/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Approximately 750,000 people in the U.S. live with end-stage kidney disease (ESKD); the majority receive dialysis. Despite the importance of adherence to dialysis, it remains suboptimal, and one contributor may be patients' insufficient capacity to cope with their treatment and illness burden. However, it is unclear what, if any, differences exist between patients reporting high versus low treatment and illness burden. METHODS We sought to understand these differences using a mixed methods, explanatory sequential design. We enrolled adult patients receiving dialysis, including in-center hemodialysis, home hemodialysis, and peritoneal dialysis. Descriptive patient characteristics were collected. Participants' treatment and illness burden was measured using the Illness Intrusiveness Scale (IIS). Participants scoring in the highest quartile were defined as having high burden, and participants scoring in the lowest quartile as having low burden. Participants in both quartiles were invited to participate in interviews and observations. RESULTS Quantitatively, participants in the high burden group were significantly younger (mean = 48.4 years vs. 68.6 years respectively, p = <0.001). No other quantitative differences were observed. Qualitatively, we found differences in patient self-management practices, such as the high burden group having difficulty establishing a new rhythm of life to cope with dialysis, greater disruption in social roles and self-perception, fewer appraisal focused coping strategies, more difficulty maintaining social networks, and more negatively portrayed experiences early in their dialysis journey. CONCLUSIONS AND RELEVANCE Patients on dialysis reporting the greatest illness and treatment burden have difficulties that their low-burden counterparts do not report, which may be amenable to intervention.
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Affiliation(s)
- Kasey R. Boehmer
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- * E-mail:
| | - Kathleen H. Pine
- College of Health Solutions, Arizona State University, Phoenix, Arizona, United States of America
| | - Samantha Whitman
- Human & Social Dimensions of Science & Technology, Arizona State University, Phoenix, Arizona, United States of America
| | - Paige Organick
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Anjali Thota
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Nataly R. Espinoza Suarez
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Christina M. LaVecchia
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Neumann University, Aston, Pennsylvania, United States of America
| | - Alexander Lee
- Health Services Research, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Emma Behnken
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Bjorg Thorsteinsdottir
- Knoweldge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Community Internal Medicine, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Aditya S. Pawar
- Neprhology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Annika Beck
- Bioethics, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Elizabeth C. Lorenz
- Neprhology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Robert C. Albright
- Neprhology and Hypertension, Mayo Clinic, Rochester, Minnesota, United States of America
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Eton DT, Linzer M, Boehm DH, Vanderboom CE, Rogers EA, Frost MH, Wambua M, Vang M, Poplau S, Lee MK, Anderson RT. Deriving and validating a brief measure of treatment burden to assess person-centered healthcare quality in primary care: a multi-method study. BMC FAMILY PRACTICE 2020; 21:221. [PMID: 33115421 PMCID: PMC7594460 DOI: 10.1186/s12875-020-01291-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/19/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In primary care there is a need for more quality measures of person-centered outcomes, especially ones applicable to patients with multiple chronic conditions (MCCs). The aim of this study was to derive and validate a short-form version of the Patient Experience with Treatment and Self-management (PETS), an established measure of treatment burden, to help fill the gap in quality measurement. METHODS Patient interviews (30) and provider surveys (30) were used to winnow items from the PETS (60 items) to a subset targeting person-centered care quality. Results were reviewed by a panel of healthcare providers and health-services researchers who finalized a pilot version. The Brief PETS was tested in surveys of 200 clinic and 200 community-dwelling MCC patients. Surveys containing the Brief PETS and additional measures (e.g., health status, medication adherence, quality of care, demographics) were administered at baseline and follow-up. Correlations and t-tests were used to assess validity, including responsiveness to change of the Brief PETS. Effect sizes (ES) were calculated on mean differences. RESULTS Winnowing and panel review resulted in a 34-item Brief PETS pilot measure that was tested in the combined sample of 400 (mean age = 57.9 years, 50% female, 48% white, median number of conditions = 5). Reliability of most scales was acceptable (alpha > 0.70). Brief PETS scores were associated with age, income, health status, and quality of chronic illness care at baseline (P < .05; rho magnitude range: 0.16-0.66). Furthermore, Brief PETS scores differentiated groups based on marital and education status, presence/absence of a self-management routine, and optimal/suboptimal medication adherence (P < .05; ES range: 0.25-1.00). Declines in patient-reported physical or mental health status over time were associated with worsening PETS burden scores, while improvements were associated with improving PETS burden scores (P < .05; ES range: 0.04-0.44). Among clinic patients, 91% were willing to complete the Brief PETS as part of their clinic visits. CONCLUSIONS The Brief PETS (final version: 32 items) is a reliable and valid tool for assessing person-centered care quality related to treatment burden. It holds promise as a means of giving voice to patient concerns about the complexity of disease management.
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Affiliation(s)
- David T Eton
- Department of Health Sciences Research, Mayo Clinic, Harwick Building, Second Floor, 200 First St SW, Rochester, MN, 55905, USA. .,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
| | - Mark Linzer
- Hennepin Healthcare, Minneapolis, MN, USA.,University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Catherine E Vanderboom
- Department of Health Sciences Research, Mayo Clinic, Harwick Building, Second Floor, 200 First St SW, Rochester, MN, 55905, USA
| | | | | | - Mike Wambua
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Miamoua Vang
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Sara Poplau
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Minji K Lee
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
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